Relationship between caries and level of metabolic balance in children and adolescents with insulin-dependent diabetes mellitus.

The relationship between the occurrence of caries and diabetes was explored in 80 children and adolescents with insulin-dependent diabetes mellitus. The mean age of the subjects was 14.5 years (range 11.7-18.4 years) and duration of diabetes 0.3-15.0 years (mean 6.0 years). DFS indices in poorly controlled subjects (glycosylated haemoglobin, HbA1, values over 13%) were significantly higher than in moderately (HbA1 10.0-12.9%) or in well-controlled cases (HbA1 values < 10%). However, the difference was not statistically significant if adjustments were made for age, age at the onset of diabetes and duration of diabetes (p = 0.1, Ancova). Subjects with caries and/or fillings had significantly higher short- and long-term HbA1 values than subjects with intact teeth, both if all subjects or subjects with long-term disease (duration of diabetes of at least 2 years, n = 62) were included. This finding was valid after adjustments for age, duration of diabetes and age at the onset of diabetes. Association between poor control and the loss of intact dentition was also demonstrated in subjects whose diabetes was diagnosed before the age of 7. Presence of yeasts was highly associated with poor control of diabetes, and yeasts were more frequently found in the saliva samples of subjects with decayed and/or filled teeth. Instead, salivary flow rates, salivary lactobacilli and Streptococcus mutans counts, buffering capacity and pH were not different between the subjects. As well, home care practices were similar, and all subjects had received similar regular dental treatment. In conclusion, poor control of diabetes was found to be associated with caries. The presence of yeasts may be a caries risk indicator in subjects with diabetes, since diabetes may enhance yeast growth, particularly if poorly controlled.